Black Prostate Cancer Patients Less Likely to Go Under the Knife During Pandemic

The odds of undergoing surgery for prostate cancer were significantly lower for Black patients compared with white patients during the initial wave of the COVID-19 pandemic, according to a retrospective cohort study.

Just 1% of Black men with untreated nonmetastatic prostate cancer underwent prostatectomy from March to May 2020 compared with 26% of white men, despite a similar rate of prostatectomy between the two groups during the same 3 months in 2019 (17.7% vs 19.1%), reported Andres Correa, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues.

This represented a 90.9% lower rate of prostatectomies among Black patients during the pandemic compared with a 17.4% lower rate among white patients, they noted in JAMA Oncology.

And while it wasn’t unusual to restrict cancer surgeries at the beginning of the pandemic so that hospitals could prioritize patients who required emergency care, sites with higher proportions of Black patients were more likely to be affected by these restrictions.

While the team found that surgical rates varied widely from site to site, ranging from a complete shutdown to a 33% increase in surgical procedures, 40.5% of the patients at the two most affected sites were Black, while 81.7% of patients at sites least affected were white.

In an accompanying editorial, Randy Vince Jr., MD, of the University of Michigan in Ann Arbor, pointed out that the study’s findings are consistent with other research that showed that the COVID-19 pandemic has disproportionately affected poor Black, Indigenous, and Hispanic communities.

Correa and colleagues used the Pennsylvania Urologic Regional Collaborative (PURC) — a prospective collaborative of 11 urology practices in Pennsylvania and New Jersey — to identify and evaluate men who received a diagnosis of nonmetastatic prostate cancer. Of the included 647 men, 172 (26.6%) were non-Hispanic Black, and 475 (73.4%) were non-Hispanic white.

They compared prostatectomy rates between Black and white patients during the first 3 months of the COVID-19 pandemic (269 patients [76 Black, 193 white] from March 16 to May 15, 2020) and during the comparable 3 months prior to the pandemic (378 patients [96 Black, 282 white] from March 11 to May 10, 2019).

Both groups had similar COVID-19 risk factors and biopsy Gleason grade groups. Furthermore, despite the lower surgery rates, Black men had higher pre-biopsy median prostate-specific antigen (PSA) levels compared with white men (8.8 ng/mL vs 7.2 ng/mL).

“Black men were younger, making them an even higher priority for surgical management,” the authors observed.

Correa and colleagues acknowledged that the study was a retrospective review of a regional cohort and may not be generalizable to the general population. However, the cohort included a broad sample of facility types and regions, including areas that are less densely populated and were less affected by the initial pandemic, they pointed out.

In addition, they suggested that it could be hypothesized that patients may have been diverted to outpatient therapeutics during this time to receive radiotherapy, which could explain some of the decrease in surgeries. “Although PURC was designed to capture prostate cancer care delivered by urologists (e.g., biopsies, active surveillance, and prostatectomies), subsequent treatment after enrollment is captured, and no concurrent increase in radiotherapy was noted,” the authors wrote.

“Given that it is generally accepted that prostate cancer treatment can be delayed, on an institutional level, each site tailored its approach and balanced the needs of its own community,” they noted. “When viewed at the systems level, however, facilities with greater reductions in surgery cared for more patients from racial minority communities, which was associated with a decrease in treatment for Black patients with prostate cancer. This trend provides a window into the intrinsic biases present within our health care system and is likely unfolding across medicine.”

“Only after recognizing and acknowledging how structural racism has affected our institutions and policies can we move forward in making change,” Vince wrote. “Without reconciliation, we will continue to find ourselves in a brutal cycle, yielding intergenerational poverty and trauma, which have substantial ramifications on our patients’ health.”

“We physicians have tremendous social and political capital,” he concluded. “It is time for us to leverage this capital to make the changes needed to promote equity.”